Intussusception describes the invagination of one portion of the bowel into the lumen of the adjacent bowel, most commonly around the ileo-caecal region.

Intussusception usually affects infants between 6-18 months old. Boys are affected twice as often as girls

Features

• intermittent, severe, crampy, progressive abdominal pain
• inconsolable crying
• during paroxysm the infant will characteristically draw their knees up and turn pale
• vomiting
• bloodstained stool - 'red-currant jelly' - is a late sign
• sausage-shaped mass in the right upper quadrant

Investigation

• ultrasound is now the investigation of choice and may show a target-like mass

Management

• the majority of children can be treated with reduction by air insufflation under radiological control, which is now widely used first-line compared to the traditional barium enema
• if this fails, or the child has signs of peritonitis, surgery is performed